It’s a Saturday morning in Rumonge province in Burundi, and the waves of Lake Tanganyika are calm as the sun rises behind the mountains to the east. The fishing site is quiet: this is the time for fishermen to repair their boats ahead of a busy week of nights working the lakeshores.

Ladislas Ndikumana, a 49-year-old fisherman and a father of six children, is among them. A fisherman for more than 15 years now, Ndikumana says that since the launch of a government initiative to improve health in the fishing community, the well-being of his family and his community in general has improved drastically.

“Before we suffered a lot, and we didn’t know how to approach the health workers and how to proceed to be treated, but now a lot has changed. If we get health , health workers and centres are very near to us and we can easily access and they help us so much,” said Ndikumana.

Historically, Burundi’s fishing community – estimated to directly and indirectly include some 40,000 people – has been particularly vulnerable in terms of public health. But in 2013, the Burundi government, in partnership with development partners, kicked off a pilot project in Rumonge aimed at improving the health of fishers and fishmongers. In 2020, the project entered its formal Phase I, and expanded beyond the initial province. It’s now known locally under the French acronym, SAPEMA.

“We encourage [fishers and fishmongers] to go to health centres, which were built nearby the lake shore, because normally during daytime, that’s when the preventive measures are available – including family planning, vaccination for children”

– Dr Martial Ngabirano, SAPEMA project manager

The project targets better access to prevention and care in a range of health areas, including sexual and reproductive health, HIV/AIDS and other sexually-transmitted infections, hepatitis, tuberculosis, malaria and gender-based violence.

Ndikumana describes how fishers and fishmongers were provided with special cards, which they present at referral hospitals to be prioritised for treatment, “so now they know that we are expected to rest during daytime since we work at night… they give us priority and not to be put in long queues.”

That change has made screening for diseases more commonplace. Fishermen used to go to the hospital only when they were in critical condition, Ndikumana says. “When we got sick, we used to think it was something related to witchcrafts. And most of us thought we can’t be infected with HIV/AIDS, for example, but now many know their statuses earlier and follow doctors’ advice.”

According to SWAA-Burundi (Society for Women Against AIDS in Africa), one of the local organisations in Burundi that helps with the implementation of SAPEMA, the total number of people in the different fishing communities in Burundi who have been referred to health care facilities stands at approximately 9,500.

SWAA-Burundi says the reason why this project was put in place is because fishers and fishmongers had become something of a forgotten community.  

“These are the people who are exposed to sexually transmitted infections like AIDS [at high rates],” said Dr Martial Ngabirano, SAPEMA project manager. “The pilot programme was conducted in Rumonge from 2013 to 2019 and the first phase started from 2020 to 2023, so the second phase was launched, which includes Lake Cohoha and Lake Rweru in Kirundo.”

According to SWAA-Burundi, a variety of health challenges are endemic to the fishing communities, including unwanted pregnancy, family conflicts and lack of knowledge about communicable diseases like tuberculosis, HIV, STDs, malaria, hepatitis, as well as low levels of education on maternal health care and gender-based violence.

“We encourage [fishers and fishmongers] to go to health centres, which were built nearby the lake shore, because normally during daytime, that’s when the preventive measures are available – including family planning, vaccination for children,” said Dr Ngabirano.

According to the Burundian government, the SAPEMA project seeks to anchor as near as possible to the fishers’ place of living and work. The programme has now reached 18 fishing sites countrywide, which the government says has now reached 100% of the fishing communities around Lake Tanganyika.

SWAA-Burundi says that in Burundi there are several groups at elevated risk of HIV/AIDS and sexually transmitted infections.

A National Strategic Plan survey was conducted in 2013 on the fishing sites of Karonda, Rumonge and Kizuka, indicating a prevalence rate of 7.3% (9.5% for women and 4.2% for men), demonstrating the vulnerability of communities, especially women, near ports and fishing sites.

Government data indicates that before the project, fishermen were one group that did not adequately benefit from public health interventions.

“We now conduct training of the trainers so that it can be easy for the fishermen and fishmongers to be educated and sensitised by people they are close to, or by their own people,” said Dr Ngabirano.

The current phase which is the second phase will run from January 2024 to December 2027.

The SAPEMA Phase 2 project carries out its activities on the coast of Lake Tanganyika, in the provinces of Bujumbura, Bujumbura Mairie, Rumonge and Makamba and in the northern Lakes on Lake Cohoha in Kirundo and Lake Rweru in Muyinga.